Quality of life in breast cancer. Part I: Physical and social well-being.
TL;DR: The results of a qualitative, descriptive study evaluating the quality of life (QOL) of 21 breast cancer survivors are presented, based on a conceptual model of QOL including physical, psychological, social, and spiritual well-being.
Abstract: Almost 2 million breast cancer survivors reside in the United States. An increase in consumer advocacy and media attention to this disease has helped bring breast cancer survivorship to the forefront of public attention. This has led to increased attention on quality of life(QOL) issues for these su
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TL;DR: Women with recurrent breast cancer are in need of programs to assist them with the severe effects of the disease on their quality of life, and programs need to include family members to help counteract the negative effects ofThe recurrent disease onTheir mental health, and to enable them to continue as effective caregivers.
Abstract: PURPOSE: Little information is available about the effects of recurrent breast cancer on the quality of life of women and their family members. The present study assessed patients’ and family members’ quality of life within 1 month after recurrence, and effects of multiple factors on quality-of-life scores. PATIENTS AND METHODS: Patient/family member dyads (N = 189) participated in this study. A stress-appraisal model guided selection of person factors, social/family factors, illness-related factors, appraisal factors, and quality of life, measured with psychometrically sound instruments. Quality of life was measured with both generic (Medical Outcomes Study SF-36) and cancer-specific (Functional Assessment of Cancer Therapy) scales. RESULTS: Patients reported significant impairments in physical, functional, and emotional well-being. Family members reported significant impairments in their own emotional well-being. Structural equation modeling revealed that self-efficacy, social support, and family hardin...
405 citations
TL;DR: A series of already existing generic and disease‐specific health status measures were used and considered as determinants of people's QoL, whereasQoL itself was conceived as a general “value judgment” about one's life.
Abstract: Summary: Purpose: Part of our research intended to explain “Quality of Life” (QoL) differences between people with epilepsy. To this end, a series of already existing generic and disease-specific health status measures were used. In this study, they were considered as determinants of people's QoL, whereas QoL itself was conceived as a general “value judgment” about one's life.
Methods: From the records of four outpatient clinics, 210 persons with epilepsy were randomly selected. During their visit to the outpatient clinic, they completed a questionnaire assessing, among other things, health perceptions and social and psychological functioning. Additional information about their medical and psychosocial status was gathered from the patient files. Data were analysed by using a hierarchical regression analysis.
Results: In decreasing order of importance, “psychological distress,”“loneliness,”“adjustment and coping,” and “stigma perception” appeared to contribute most significantly to the outcome QoL as judged by the patients themselves, regardless of their physical status. In the final model, none of the clinical variables (onset, seizure frequency, side effects of antiepileptic drugs) contributed significantly anymore to the patients' “quality-of-life judgement.” Apparently the effect of other variables such as seizure frequency and health perceptions, medication and side effects, life fulfilment, self-esteem, and mastery is mediated by these variables.
Conclusions: Because all of the variance in QoL of the patients was explained by the psychosocial variables included in this study, health professionals should be aware of the significance of the psychosocial functioning of the patients and the role it plays in the achievement of a good QoL. Both informal and professional support may be an adjunct to conventional treatment. In future research, this issue should be given high priority.
330 citations
Cites background from "Quality of life in breast cancer. P..."
...QoL is now often defined as the “individual’s overall satisfaction with life and their general sense of well-being” (21) and comprises mostly three to six dimensions or life domains (15,18,21,22)....
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TL;DR: Study results demonstrated that although perceived social support and uncertainty accounted for a significant amount (27.2%) of variance of quality of life, a large amount of variance remains unexplained.
Abstract: The purpose of this study was to examine the influence of the nurses' knowledge, attitudes, and health beliefs on their behavior and their actual usage of safety measures while handling cytotoxic drugs in their daily work surroundings. The Health Belief Model (HBM) and its extensive form, the Protection Motivation Theory (PMT), were used as the theoretical frameworks. Sixty-one nurses participated in the study, 31 hospital-based nurses daily exposed to cytotoxic drugs for the last 5 years, and 30 non-exposed community nurses. An occupational questionnaire was used to test the nurses' actual safe behavior and compliance with the recommended guidelines. A randomly selected group of exposed nurses were observed to validate their compliant behavior. A gap was found between the nurses' knowledge and their actual behavior concerning the potential risks of cytotoxic drugs and their use of protective measures (p < .005). Significant correlations were found among the components of the extensive HBM (perceived susceptibility, barriers, benefits and self-efficacy). The observational findings supported the above results. The study's findings support the need to promote primary prevention by providing a safe environment for the employee by means of education, training with regard to safety measures, clear policy, written guidelines and their enforcement.
271 citations
TL;DR: Qualitative studies show that patients with lymphoedema experience greater levels of functional impairment, poorer psychological adjustment, anxiety and depression than the general population, and there is some evidence that the adoption of patient‐centred guidelines can improve quality of life in patients with breast‐cancer‐related lymphoingema.
Abstract: This article reviews qualitative and quantitative studies that evaluate health-related quality of life (HRQoL) in lymphoedema. Qualitative studies reveal a number of factors that can affect HRQoL. These include a lack of understanding of lymphoedema by health professionals and poor information provided to patients. Emotional responses include shock, fear, annoyance, frustration and negative body image. Treatment can be costly in terms of time and disruption to lifestyle. Quantitative studies show that patients with lymphoedema experience greater levels of functional impairment, poorer psychological adjustment, anxiety and depression than the general population. Increased limb volume is poorly related to the impact of lymphoedema on the patient. Factors leading to deficits in quality of life include the frequency of acute inflammatory episodes, the presence of pain, skin quality, lymphoedema in the dominant hand and reduced limb mobility. There is some evidence that the adoption of patient-centred guidelines can improve quality of life in patients with breast-cancer-related lymphoedema. HRQoL is an important outcome in the management of patients with lymphoedema. Further studies must examine how lymphoedema impacts on patients other than those with breast-cancer-related lymphoedema and the consequences to patients of different approaches to care.
223 citations
TL;DR: It is found that women continue to experience a variety of physical and psychological symptoms and have concrete information and support needs following therapy, including the need for information on persistent treatment effects, emotional distress, and lifestyle changes.
Abstract: Women living with and beyond breast cancer have special health care needs. Persistent physical and psychological symptoms such as fatigue, pain, sleep disturbances, and fear of recurrence as well as quality-of-life outcomes have been described in women during and after breast cancer. Much less information exists on the experience of women completing treatment. This study describes the information and support needs of women following breast cancer treatment. A semistructured interview guide designed by the research team was used to gather data. Major findings indicate that women continue to experience a variety of physical and psychological symptoms and have concrete information and support needs following therapy, including the need for information on persistent treatment effects, emotional distress, and lifestyle changes. Findings illustrate that there is need to provide comprehensive information and support to help women transition from breast cancer therapy. Additional research is needed to optimize ap...
221 citations
Cites background from "Quality of life in breast cancer. P..."
...The findings indicate that survivors often feel unprepared for the side effects that linger after therapy (Ferrell et al., 1997; Ganz et al., 2004)....
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TL;DR: In this paper, the authors propose a more helpful and accurate appraisal of the collective and individual state of people than objective, econo-conco-factual measures of quality of life or subjective well-being.
Abstract: Recent attempts to measure the quality of life or subjective well-being show promise for a more helpful and accurate appraisal of the collective and individual state of people than objective, econo...
1,355 citations
TL;DR: With an increasing number of women surviving breast cancer beyond treatment, the focus of care has shifted from the acute treatment-related side effects to long-term effects associated with changes in quality of life (QOL) as mentioned in this paper.
Abstract: With an increasing number of women surviving breast cancer beyond treatment, the focus of care has shifted from the acute treatment-related side effects to long-term effects associated with changes in quality of life (QOL). Part I of this article described the impact of breast cancer on the domains
384 citations
TL;DR: Evaluated breast cancer survivors experienced long-term changes after completion of treatment which affected overall quality of life, however, many positive benefits were also gained which helped to balance the worse outcomes.
Abstract: Attention to the quality of life (QOL) among long-term of breast cancer is long overdue. Modest improvements in overall survival have led to a greater emphasis on how women are living with the disease. The purpose of this paper is to report the results of a descriptive study that evaluated the quality of life of 294 breast cancer survivors, and to review the continuum of positive and negative QOL outcomes in this population. Members of the National Coalition for Cancer Survivorship (NCCS) were surveyed and received two QOL instruments: the Quality of Life — Cancer Survivors Tool (QOL-CS) and the Functional Assessment of Cancer Therapy (FACT-G), and a demographic data tool. The main research variables were the subscales (Physical, Psychological, Social, and Spiritual Well-being) and individual items of the QOL-CS and the FACT-G. Results indicated that: a) fatigue, aches and pains, and sleep problems were persistent after treatment ended; b) psychological distress from cancer diagnosis and treatment, and fear of recurrent, metastatic, and recurrent disease were problematic over time; c) family distress, sexuality, and family burden issues were of greatest social concern; and d) uncertainty over the future plagued breast cancer survivors long-term. Breast cancer survivors also reported good outcomes in hopefulness, having a life purpose, and having a positive change after the treatment. Conclusions: breast cancer survivors experienced long-term changes after completion of treatment which affected overall quality of life. However, many positive benefits were also gained which helped to balance the worse outcomes.
382 citations
TL;DR: The combined results from multiple studies provide strong evidence that menopausal therapy consisting of 0.625 mg/d or less of conjugated estrogens does not increase breast cancer risk.
Abstract: We conducted a meta-analysis of the literature concerning breast cancer and estrogen replacement therapy. The overall relative risk of breast cancer associated with this therapy was 1.07. However, the variation of the estimated risks among the studies was far greater than could plausibly be explained by chance alone. To explain this variation, we looked at the effects of type, duration, and dosage of treatment. Overall, women who took 0.625 mg/d or less of conjugated estrogens had a risk of breast cancer that was 1.08 times that of women who did not receive this therapy (95% confidence interval [CI], 0.96 to 1.2). The relative risks from these individual studies of low-dosage therapy did not differ significantly from each other. Women who took 1.25 mg/d or more of conjugated estrogens had a breast cancer relative risk of 2.0 or less in all studies. However, the variation in observed risks at this higher dosage was significant. This implies that other risk factors varied among these studies, making it difficult to estimate the overall risk associated with this dosage. The relative risk of breast cancer associated with estro gen replacement therapy among women with a history of benign breast disease was 1.16 (95% CI, 0.89 to 1.5). The combined results from multiple studies provide strong evidence that meno pausal therapy consisting of 0.625 mg/d or less of conjugated estrogens does not increase breast cancer risk. (Arch Intern Med.1991;151:67-72)
364 citations
Journal Article•
TL;DR: Cancer survivors experienced altered lives and had needs related to fear of recurrence and facing the spiritual aspects of having survived a life-threatening illness.
Abstract: Purpose/objectives To describe the quality of life (QOL) of long-term cancer survivors Design Descriptive, mailed survey Setting Membership of the National Coalition for Cancer Survivorship (NCCS), which is a nonprofit, peer-support network for people living with cancer Sample 687 (57%) of the 1,200 members of NCCS completed the survey The mean age of the sample was 496 years; 81% were female The predominant cancer diagnoses were breast (43%), lymphoma (9%), ovarian (8%), and Hodgkin's disease (8%) Methods Mailed survey using three instruments: a demographic tool, the Quality of Life-Cancer Survivors (QOL-CS) tool, and the Functional Assessment of Cancer Therapy-General (FACT-G) tool Main research variables Subscale and individual items of QOL including physical, psychological, social, and spiritual well-being Findings Results include areas of positive effects for cancer survivors and continued demands of survivorship Based on scoring of 0 (worst outcome) to 10 (best outcome), cancer survivors' mean QOL-CS subscores were 588 for psychological well-being, 659 for spiritual well-being, 662 for social well-being, and 778 for physical well-being Several demographic factors (eg, evidence of active disease; female gender; presence of spouse/partner or children; length of time since diagnosis; income) had significant influence on QOL Conclusions Cancer survivors experienced altered lives and had needs related to fear of recurrence and facing the spiritual aspects of having survived a life-threatening illness Implications for nursing practice The growing population of cancer survivors has long-term needs for nursing care that address multidimensional aspects of QOL
342 citations